1st expert group meeting

Epidemiology and surveillance of Hepatitis E virus in EU/EEA: an inventoryCornelia Adlhoch, SRSEuropean Centre for Disease Prevention and ControlStockholm, 09-10 December 2015

From: Influenza and other respiratory viruses

Causality* (also referred to as 'causation',[1] or 'cause and effect') is the relation between one process (the cause) and another (the effect), where the first is understood to be partly responsible for the second. In Aristotelian philosophy, the word 'cause' is also used to mean 'explanation' or 'answer to a why question', including Aristotle's material, formal, efficient, and final "causes"; then the "cause" is the explanans for the explanandum.

*www.Wikipedia.com

To:Hepatitis E virus

Hepatitis E virus

Hepatitis E virus (HEV)

• Hepatitis E virus (HEV) is considered to be one of the most common causes of acute hepatitis worldwide

• Four different genotypes infecting people with different geographical distribution, source of infection and pathogenicity

Kamar N, et al. Hepatitis E. Lancet. 2012 Jun 30;379(9835):2477–88

Hepatitis E virus (HEV) in Europe

• Earlier, most cases were travel-related, imported from HEV-endemic areas

• HEV gt 3 is endemic in Europe with animal reservoir

• HEV infections in Europe more prevalent than expected

• Increasing numbers of autochthonous cases are reported across Europe

• Regions with high seroprevalence described (South of France)

Surveillance of HEV in Europe

• HEV is not under EU-wide surveillance

• No harmonised case definition or reporting system

• Reporting systems, case definitions and populations under surveillance rely on national policies

HEV in the media

http://www.bbc.com/news/health-30006977http://www.dailymail.co.uk/news/article-2592090/Hidden-risk-one-ten-sausages-Hepatitis-E-pork-making-tens-thousands-ill-say-government-experts.html

http://www.thesundaytimes.co.uk/sto/news/uk_news/Health/article1603237.ece?CMP=OTH-gnws-standard-2015_09_05

Increase of HEV cases in EU countries

UK

Germany

Animal source

www.bz-berlin.de

www.jaegermeister.de

www.faz.de

Source of infectionHepatitis E virus antibody prevalence in hunters from a district in Central Germany, 2013: a cross-sectional study providing evidence for the benefit of protective gloves during disembowelling of wild boarsSchielke et al 2015

http://www.supertoinette.com/fiche-cuisine/1391/figatelli.html

© 2015 LES ÉDITIONS ALBERT RENÉ

Hepatitis E seroprevalence in European blood donors

Country/region Seroprevalence (IgG) Positive association with Authors

France 39% geographical variations from 20–71%

22.4%geographical variations from <10% to >80%

Uncooked pork liver sausages, increasing age, eating offal or mussels

N/A

Mansuy JM, et al. Eurosurveillance;2015.

Mallet V. Global Viral Hepatitis Summit, Berlin 2015.

Netherlands 27% adults under 30 years: 13% adults over 60 years: 43%

Intensive pig farming as amplifier (?) for virus spread

Slot E, et al. Eurosurveillance; 2013.

Denmark 20.6% among farmers 50.4%

Contact with horses, presence of antibodies to hepatitis A

Christensen PB, et al. Clin Infect Dis; 2008.

England 16% Older age, male sex Dalton HR, et al. Eur J Gastroenterol Hepatol; 2008.

Germany 6.8% 5.9%*

N/A* HEV genotype 3 closely related to German HEV strains from wild boars, pigs and human hepatitis E cases

Juehl D, et al. Transfusion; 2014.Vollmer T, et al. J Clin Microbio; 2012.

Italy 1.3% (very small sample size)

N/A Scotto D, et al. Blood Transfus; 2012.

HEV related to transplantation/transfusion

Role of ECDC

The ECDC founding regulations specifies the mandate of ECDC regarding risk identification and

risk assessment. Under this regulation, the Centre shall:

• Identify and assess emerging threats to human health from

communicable diseases;

• Establish, in cooperation with the Member States, procedures for

systematically searching for, collecting, collating and analysing

information and data with a view to the identification of emerging

health threats which may have mental as well as physical health

consequences and which could affect the Community

The role of the ECDC is providing support to the European Commission on the implementation

of Decision 1082/2013/EU of the European Parliament and of the Council of 22 October 2013

on serious cross border threats to health and repealing Decision No 2119/98/EC.

Key objectives

Based on the above, ECDC has identified a need to explore and assess closer the emerging threat of HEV to humans in EU/EEA. The key objectives of this inventory of HEV in Europe are to:

• describe surveillance systems in place, applied case definitions and laboratory methods for diagnosis

• collect case numbers, where possible, to describe epidemiology, burden and severity (clinical picture) across Europe

• describe populations at risk

• identify rationale and objectives of surveillance at EU/EEA level

Methods

1. Establishment of an expert groupMembers are nominated experts from the EU/EEA MS + 3 external scientific experts + EFSA + WHO

2. Member State survey Ask EU/EEA MS to describe surveillance systems in place, applied case definitions and laboratory methods for diagnosis, collect case numbers, where possible

3. Systematic literature reviewThe review question for the ECDC systematic review is:

“What is the seroprevalence and/or incidence of HEV antibodies over the last 10 years (2005-recent) in different populations surveyed in the EU/EEA MS by country and/or region”

Terms of reference of the expert group

Support ECDCs initiative to create an inventory and identify areas of action for HEV across Europe by contributing as expert in 2015 and 2016.

• To support the collection of data and pilot test the survey questionnaire on these (literature review and MS survey)

• To agree on indicators/parameters to be collected

• To assess the need for

– Monitoring the emergence of human HEV infections in EU/EEA;

– Provide options for monitoring purposes to be further discussed with the ECDC Advisory Forum;

– EU level guidance on diagnostic procedures

– Risk assessment for transfusion/transplantation-related transmission

– Prevention strategies for severe and chronic cases

• To support the drafting of a summary report on the study, including proposed next steps at EU level (in 2016)

Objective of this meeting

• To provide an overview of the epidemiology and virology of HEV, on

national surveillance systems, case definitions, detection systems as well

as recommendations and guidelines in place

• To share EU Member State experiences on HEV

• To describe gaps and opportunities at EU/EEA level in responding to the

health risks related to HEV

• To identify rationale and objectives of surveillance at EU/EEA level

• To recommend and prioritise actions needed at EU level to fill in the gaps

Thank you

© 2015 LES ÉDITIONS ALBERT RENÉ

EU/EEA MS survey

Objective and time line

• Questions:• Surveillance systems in place

• Applied case definitions

• Laboratory methods for diagnosis

• Number of cases, where possible

• Piloted in 3 countries (Germany, the Netherlands, the UK)• Incorporation of points discussed during the meeting• To be sent out end of 2015/early 2016• Data available May 2016